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Factors influencing the treatment of osteoporosis following fragility fracture

Osteoporosis International volume 20, Article number: 1911 (2009) Cite this article

Abstract

Summary

Treatment rates of osteoporosis after fracture are very low. Women who suffer a fragility fracture have a greater chance of receiving anti-fracture treatment if they had low bone mineral density (BMD), a fracture at the hip, femur or pelvis, administration of calcium and vitamin D supplements and/or an age ≥60 years.

Introduction

This investigation identifies the predictors of osteoporosis treatment 6 to 8 months following fragility fracture in women >50 years of age.

Methods

In this prospective cohort study, women were recruited 0 to 16 weeks following fracture and classified as having experienced fragility or traumatic fractures (phase 1). Six to 8 months following fracture, women completed a questionnaire on demographic features, clinical characteristics and risk factors for osteoporosis (phase 2). Osteoporosis treatment was defined as initiating anti-fracture therapy (bisphosphonate, raloxifene, nasal calcitonin and teriparatide) after fracture in those previously untreated.

Results

Of the 1,273 women completing phase 1, 1,001 (79%) sustained a fragility fracture, and of these women, 738 were untreated for osteoporosis at phase 1 and completed the phase 2 questionnaire. Significant predictors of treatment included BMD result, fracture site, administration of calcium and vitamin D supplements at the time of fracture and age ≥60 years. All other risk factors for osteoporosis, such as fracture history after the age of 40 years, family history of osteoporosis and comorbidities did not significantly influence the treatment rate.

Conclusions

Physicians largely based their decision to treat on BMD results and not on the clinical event—fragility fracture.

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Acknowledgments

We gratefully acknowledge the contributions of the ROCQ Programme staff, particularly programme coordinators Lucie Vaillancourt and Nathalie Migneault and administrative assistant Julie Parrot. We also acknowledge the contributions of the regional coordinators and research assistants: Sylvie Bélanger, Geneviève Corneau, Isabel Lajeunesse, Pierre-Antoine Landry, Lise Lemire, Anne-Marie Louis XVI, Julie Simard and Lyse Roy. Finally, we thank the regional directors, Pierre Dagenais, Kim Latendresse, Pierre Major, Frédéric Morin, Suzanne Morin and Josée Villeneuve, for their support during the implementation of the programme and their critical scientific advice. We also thank past members of the ROCQ executive, Louise Lafortune, Christine Chin, Luc Sauriol and Andy McClenaghan, for their insightful guidance. Lastly, we appreciate all CaMos investigators for allowing us to utilise pertinent sections of the CaMos questionnaires for ROCQ. The ROCQ Programme was funded by Merck Frosst Canada, Procter and Gamble Pharmaceuticals, Sanofi-Aventis Group, Eli Lilly Canada and Novartis Pharmaceuticals Canada. None of the funding sources had a role in the collection, analysis or interpretation of the data or in the decision to publish this article.

Conflicts of interest

Drs. Bessette, Brown, Davison and Ste-Marie have consulted for, held research grants and/or received honoraria from companies that market anti-fracture therapies.

Author information

Affiliations

  1. Department of Medicine, CHUL Research Centre, Laval University, 2705, Laurier Boulevard, Room S-784, Quebec City, PQ, Canada, GIV 4G2

    L. Bessette, K. S. Davison & J. P. Brown

  2. Institut National de Santé Publique du Québec, Sainte-Foy, PQ, Canada

    S. Jean & S. Roy

  3. Department of Medicine, Centre de Recherche du CHUM, Hôpital Saint-Luc, University of Montreal, Montréal, PQ, Canada

    L.-G. Ste-Marie

Authors
  1. L. Bessette
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  2. S. Jean
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  3. K. S. Davison
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  4. S. Roy
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  5. L.-G. Ste-Marie
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  6. J. P. Brown
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Corresponding author

Correspondence to L. Bessette.

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Bessette, L., Jean, S., Davison, K.S. et al. Factors influencing the treatment of osteoporosis following fragility fracture. Osteoporos Int 20, 1911 (2009). https://doi.org/10.1007/s00198-009-0898-x

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  • DOI: https://doi.org/10.1007/s00198-009-0898-x

Keywords

  • Care gap
  • Determinants
  • Fragility fracture
  • Osteoporosis
  • Treatment predictors